Price Transparency
Mastering Daily Tasks To Help Others Feel Their Best

Mastering Daily Tasks To Help Others Feel Their Best

by | Jul 12, 2024 | Neurology

Previously published in Rite Up, 2024 – Issue 2.

Fifteen-year-old Zion, of Glenn Heights, is preparing to become an esthetician when she graduates from high school. Her mother, Tiffany, bought her a mannequin that she uses to practice giving facials and applying makeup. “I want to make people feel good about themselves,” Zion says. “Being an esthetician will help people relax.” Recently, Zion brought her mannequin to Scottish Rite where she works with occupational therapist Lucy Ericson on mastering a host of daily activities.

Zion has cerebral palsy (CP) and has received care at Scottish Rite for Children since she was 10, after her family moved to Texas from Arizona. CP is the most common childhood disorder that affects muscles and movement. Zion’s symptoms impact her mobility, muscle coordination, flexibility and posture.

“It’s hard to walk around the mall, our neighborhood or around school because classes aren’t close together,” Zion says. She uses a wheelchair for long distances. “Sometimes, I force myself to walk, but I get very tired.” She also finds it challenging to do things with her right hand, like twisting open a jar, pouring juice or writing essays. “It’s hard keeping my hand straight,” she says, “but that’s why we go to Lucy.”

In occupational therapy, Zion works through a list of tasks that she conquers one by one. Lucy has helped her find creative ways to brush her teeth, wash her skin, cook food, open a pill bottle, roll her wheelchair by herself, get binders in and out of her backpack, put on earrings and apply makeup, like eye shadow and lip gloss. “It makes me feel really good,” Zion says. “I never thought I was going to be able to do all that stuff by myself.”

As tasks get easier for Zion to achieve, she prepares for her future as an esthetician. “Zion wants to be ready when she graduates so there aren’t any barriers,” Tiffany says. In a session with Lucy, Zion massages the mannequin’s face with shaving cream. “We’re not using the high-end stuff on a mannequin,” Tiffany says, laughing, but then, her tone turns bittersweet as she considers the years they have spent at Scottish Rite. “They make us feel like we are part of one big family,” she says. Zion underscores how much it means to her. “I really love, gosh, all the people,” she says. “I couldn’t imagine myself being able to do what I can do without Scottish Rite’s help.”

Read the full issue.

Supporting the Mental Aspects of Recovery after an ACL Reconstruction

Supporting the Mental Aspects of Recovery after an ACL Reconstruction

by | Jan 9, 2024 | Sports Medicine

Anterior cruciate ligament injuries (ACL) continue to be a problem in youth sports such as basketball and soccer. Many athletes and families are very aware of the lengthy physical aspect of returning to sport after an ACL injury and surgery. Some are surprised by the mental challenges and demands that come along with an injury. Patients, like Johanna, are supported by our multi-disciplinary team from the moment they walk into our sports medicine clinic.

Watch Johanna tell her story.

Physical therapist Rushi Patel says, “a lot of times people talk about the physical aspect of an ACL initial injury but you could argue the mental aspect is just as hard.”

Upon arrival, our team begins assessing a new patient from the “inside out.” We ask questions about how the athlete was injured, what level of competition they want to return to and what challenges they are facing physically and mentally in addition to the injury. These help us decide who needs to be involved in the athlete’s care from day one. Here are three tools we implement in our care of young athletes:

  • Certified child life specialists assist children and teens in understanding diagnoses and medical procedures, this helps to keep anticipation and fear under control.
  • Psychologists are available to consult when our clinic team or responses to screening questionnaires suggest an athlete may need more individualized guidance on pain management, coping with the injury and fears related to returning to sports.
  • Many of our patients receive stress management and pain management skill instructions to help them navigate day to day moments and the progression of rehabilitation. Download PDF.

Every team member, from nurse to physical therapist is focused on caring for kids and teens all day, every day. We use age- and developmentally appropriate strategies when we talk to kids, formulate treatment plans and create our educational materials.

Johanna says, “Scottish Rite has been like no other care I’ve gotten at a medical facility I truly feel loved and cared for and not just seen as a number or a patient with an issue to get resolved but they truly care about who I am what my goals are and ultimately what I want to accomplish in life.”

Check out how you can help us learn to prevent ACL injuries.

Progression from “Pop” Back to Pitching

Progression from “Pop” Back to Pitching

by | Oct 20, 2023 | Sports Medicine

A young baseball player hears a pop and immediately feels pain in his throwing elbow while playing club baseball. At his first visit to Scottish Rite for Children’s Fracture Clinic, Parker and his family were told that surgery was necessary to reattach a separated piece of bone in his elbow. That was tough news for this young pitcher nearing his 12th birthday.

A Note About Sport-Related Overuse Injuries in the Elbow in Baseball

Though a completely displaced fracture in this area is uncommon, pain and injury on the middle side of the elbow is common in young throwers. There are immense stresses placed on the elbow during throwing.

Many pitchers and others perform many throws during practice, private training and year-round games and tournaments, and the damage continues and worsens. For many young athletes, early recognition and rest can prevent the condition from worsening to the point of an acute injury, like a medial epicondyle avulsion fracture, that needs surgery. Learn more about preventing elbow overuse injuries in young athletes in this article, Injury Prevention Tips for Young Baseball Players and Parents.

“This area of the elbow is weak in young throwing athletes around Parker’s age, he was 11 at the time of this injury,” occupational therapist Savana Ashton says. The area is an epiphysis, a growth center, where the bone fragment is connected to the humerus by cartilage that will become bone when growth is complete. With or without a history of overuse, a sudden and forceful injury causes the muscle tendon attached to the fragment to pull it off the humerus completely, this is called an avulsion fracture. Like Parker, an athlete often describes hearing a “pop” and instantly feeling severe pain with this injury.

Parker was in good hands. Pediatric hand surgeon, Chris Stutz, M.D., performed the ORIF surgery where he used a screw to reattach the piece of bone. The procedure is called an open reduction and internal fixation (ORIF) of the medial epicondyle. After surgery to secure the bone fragment back in place, patients require intensive rehabilitation to return to activities and sports that are meaningful to them. In occupational therapy (OT), Ashton provided many therapeutic interventions including skin care and scar management as well as exercises to regain motion in the elbow and strength in the entire arm.

“From the beginning of Parker’s journey, he was eager to return to baseball, so a strategic path through postsurgical rehabilitation including safely reintroducing throwing was critical,” Ashton says. “Once Dr. Stutz cleared him for throwing, I advanced Parker’s plan to include evidence-based throwing programs, which include general baseball strengthening exercises and a multiphase guide to gradually return-to-pitching.”

Similar to other young athletes recovering from a serious sport-related injury, Parker was ready to be discharged from formal rehabilitation, but he was not quite ready to return to full activity, including baseball. In September, Parker transitioned from OT to the Bridge Program, a group training option offered by our Therapy Services team at Scottish Rite for Children. The program provides athletes like Parker a safe “bridge” to maintain progress made in therapy and continue strengthening in the previously injured area. Simultaneously, the coaches emphasize proper body mechanics and total body strength and conditioning, which will likely help reduce the risk of reinjury. “We were grateful Scottish Rite had an environment for him to continue his recovery,” Parker’s mom, Michele, says. She has entrusted Scottish Rite to care for several of her children now.

The program is not baseball-specific, but it is beneficial for baseball players and many others. Certified strength and conditioning coach Justin Haser, M.S., CSCS, says, “The kids that consistently come in, give a good effort and are coachable see great improvements in their movement economy and improvements in their overall strength outputs.” When athletes enroll in the Bridge Program or Athlete Development Program, they can attend up to three times each week.

In pediatric orthopedics, follow-up visits are particularly important when a growth area was involved in the treatment. Complications with this treatment are rare, but monitoring periodically and confirming recovery is on the right path ensures there won’t be surprises later.

Parker is now 13 and has been happily back on the mound and hitting home runs. “Parker is thrilled to be back playing baseball after his full recovery from surgery,” Michele says. To help other young throwers like himself have a safe season, Parker helped us create instructions for evidence-based exercises for all throwers. These are designed to be performed before practice or a game and can help to reduce elbow injuries.

Download the Thrower’s Program PDF (English | Spanish)

Strength and Conditioning Training: It Is Not Just About Getting Strong

by | Oct 10, 2023 | Therapy Services

What is strength and conditioning?
Strength and conditioning may better be referred to as “physical preparation.” An athlete needs to be physically capable of accomplishing the goals set by the coach to compete in the game. Benefits of strength training go beyond just getting an athlete bigger, stronger and faster. Proper training improves an athlete’s resiliency and confidence in their performance as well. Though preventing injuries may not be directly related to movement and strength training, there are studies that suggest that overuse injuries may be reduced by as much as one-half with appropriate training.

Medical Professionals Programs like this are available on-demand for a limited time Browse Now. A blue and green advertisement for medical professionals

Ideally, an athlete participating in a strength and conditioning program is:

  • At a developmentally appropriate level.
  • At a physically appropriate level.
  • Receiving proper instruction and supervision.
  • In a setting with equipment that is appropriate for both the athlete and the sport.

KEISER YOUTH TRAINING CLASSES KE 0000000 D 10 10 45 St PB 48KG. A group of young boys squatting in a gym

What is training age?
An athlete’s training age may vary across skills or activity. The “training age” is typically much lower than the chronological age. A soccer player may have started playing soccer at age 4 but didn’t start resistance training until age 12. Therefore, that athlete should not begin a strength and condition program at the level of an athlete with five years of resistance training who may be lifting weights and using other forms of resistance.

How should goals be set for a young athlete?
The goals of the program should also be individualized and progress should be tracked. Measures for strength, power, endurance and speed are commonly used. More importantly, an assessment of movement quality should be integrated in the progression. Proper form in fundamental movements should always precede increased resistance or other challenging elements of an exercise.

Younger athletes should learn that “bulking up” is not an appropriate goal for them. These changes will not occur until developmental stages where hormones are present to create those visual changes. What is more likely to occur with movement and strength training in this population are neurological changes that lead to improved neuromuscular control, which is believed to reduce the risk of knee and ankle injuries common in young athletes.

What happens after an injury?
After proper diagnosis, a transition to a supervised strength and conditioning program is ideal only after treatment and rehabilitation for a musculoskeletal injury. An athlete often completes formal physical or occupational therapy before they are ready to return to sport. Therefore, a continued progression of sport-related and other activities help the athlete to complete recovery and prepare for realistic sport environments. Complex movements and distractions that are common during competitions can be integrated into training sessions where variables are controlled.
People squatting in front of a matrix squat rack | HEME 10 45 S 17 18 13 14 15 ᏣᏃ Ec A Ec 16 16 MATRIX 18 14 10 SCOTTISH RITE FOR CHILDREN PORTS MEDICINE Jasirs 处

In a recent program for medical professionals, strength and conditioning coach Justin Haser, M.S., CSCS, and physical therapist Daniel Stokes, P.T., D.P.T., CSCS., explained how strength and conditioning is integrated in the continuum of care for healthy and injured athletes. Watch now on YouTube.

Limb Loss and Limb Differences: Terms You Need to Know

Limb Loss and Limb Differences: Terms You Need to Know

by | Apr 19, 2023 | Prosthetics & Orthotics

There are many different words that are used to describe limb loss and limb differences. These medical terms allow patients and their families to effectively communicate with their health care provider. This glossary of words and phrases will help you learn some of the terms used to describe limb differences and limb loss. 

Acquired amputation: The surgical removal of a limb(s) due to complications associated with disease or trauma.

Alignment: The position of the prosthetic socket in relation to the foot and knee.

Amputation: The surgical removal of all or part of a limb due to disease or injury.

Atrophy: A wasting away of a body part, or the decrease in size of a normally developed extremity or organ, due to a decrease in function and/or use.  After amputation, for example, some of the muscles in the remaining (residual) limb often atrophy over time since they are not being used as actively as before. 

Bilateral: Occurring on both sides, as in loss of both arms or both legs.

Check or test socket: A temporary socket, often transparent, made over the plaster model to aid in obtaining proper fit and function of the prosthesis.

Congenital limb deficiency: An absent, shortened or abnormal limb present at birth.

Custom fit: Fitting an individual with a device that is made from a scan or cast of the individual’s unique anatomy and fabricated according to the needs of that individual.

Extremity: A limb of the body, as in upper or lower extremity.

Gait: Referring to the manner or style of walking.

Gait training: Part of ambulatory rehabilitation, or learning how to walk, with your prosthesis or prostheses.

Lower extremity (LE): Relating to the leg.

Nylon sheath: A shear nylon interface worn close to the skin on the residual limb to reduce friction and to help wick away perspiration from the surface of the skin.

Orthosis: A external device that is used to protect, support or improve function of parts of the body that move, i.e., braces, splints, slings, etc. It can include anything from an arch support to a spinal orthosis. Orthoses is plural.  

Orthotics: The profession of providing devices to support and straighten the body (orthoses).

Orthotist: A skilled professional who designs, fabricates, fits and maintains orthotic devices that are prescribed by a physician, generally as a collaboration regarding the biomechanical goals of the orthosis and the patient’s needs.

Proximal Femoral Focal Deficiency (PFFD): Proximal Femoral Focal Deficiency is a complex congenital difference in which the femur (thigh bone) is short or even mostly absent, making that leg significantly shorter than normal. PFFD includes a wide range of severity and multiple treatment options based on how big the length difference is, the child’s age and development and whether other parts of the limb or other extremities are involved.

Prosthesis/prosthetic device: An artificial limb, usually an arm or a leg, that provides a replacement for the amputated or missing limb. Prostheses is plural. Generally, the word prosthetic should be used as an adjective. If referring to an individual’s replacement artificial limb, it should be called a prosthesis not just a prosthetic.

Prosthetics: The profession of providing those with limb loss or with a limb difference (congenital anomaly) a functional and/or cosmetic restoration of missing or underdeveloped human parts.

Prosthetist: A person involved in the science and art of prosthetics; one who designs and fits artificial limbs.

Pylon: A structural part, usually a metal alloy or composite tube, that provides a relatively light weight support structure between other components of the prosthesis such as between the socket or knee unit and the foot.

Residual limb: The portion of the arm or leg remaining after an amputation, sometimes referred to as a stump or residuum.

Revision: Surgical modification of the residual limb.

Socket: Part of the prosthesis that fits around the residual limb.

Symes: a type of surgery for amputation through the ankle joint, generally retaining the heel pad so that the residual limb can tolerate more loading through that area.

Upper extremity (UE): Relating to the arm.

Van Nes (Rotationplasty): Rotationplasty is a surgical reconstruction occasionally indicated for bone tumors near the knee or for PFFD.  There are many variations of this surgery, but in general the limb is shortened, and the anatomical ankle and foot are moved up to about knee level and rotated around so the heel faces forward.  Once healed the person with a rotationplasty can eventually be fitted with a “below knee” prosthetic leg where the foot rests inside a custom socket and the rotated ankle is protected with metal joints and a thigh cuff.   The ankle then controls the prosthesis much like a knee but with slightly less overall range of motion.